MARIA AUGUSTA BENTO CICARONI GIBELLI
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bookPart Infecção fúngica no recém-nascido(2022) KREBS, Vera Lúcia Jornada; GIBELLI, Maria Augusta Bento Cicaroni- Role of a Neonatal Intensive Care unit during the COVID-19 Pandemia: recommendations from the neonatology discipline(2020) CARVALHO, Werther Brunow de; GIBELLI, Maria Augusta Bento Cicaroni; KREBS, Vera Lucia Tornado; TRAGANTE, Carla Regina; PERONDI, Maria Beatriz MoliternoOn 11th March 2020, the World Health Organization (WHO) declared the COVID-19 a pandemic. The Obstetrics and Neonatology disciplines needed to be revised to suit the institutional need to expand intensive care beds to care for confirmed or suspected patients with COVID-19 in the state of Sao Paulo, following the recommendations of the Institutional Crisis Committee. Three different actions were needed: the structuring of teams and advanced medical post to attend COVID-19-free patients and those with suspect or confirmed COVID-19; elaborating the protocols from the delivery room throughout hospitalization. Some special considerations about breastfeeding and rooming-in were needed. The third action was the drafting of a protocol to admit infants from other hospitals with confirmed COVID-19 as the unit never admitted outpatients before.
- Neonatal manifestations in COVID-19 patients at a Brazilian tertiary center COMMENT(2020) BEOZZO, Glenda Priscila Neves dos Santos; CARVALHO, Werther Brunow de; KREBS, Vera Lucia Jornada; GIBELLI, Maria Augusta Bento Cicaroni; ZACHARIAS, Romy Schmidt Brock; ROSSETTO, Larissa Elizabeth Schulz; FRANCISCO, Rossana Pulcinelli Vieira
- Kidney impairment in fetal growth restriction: three-dimensional evaluation of volume and vascularization(2020) SENRA, Janaina Campos; YOSHIZAKI, Carlos Tadashi; DORO, Giovana Farina; RUANO, Rodrigo; GIBELLI, Maria Augusta Bento Cicaroni; RODRIGUES, Agatha Sacramento; KOCH, Vera Hermina Kalika; KREBS, Vera Lucia Jornada; ZUGAIB, Marcelo; FRANCISCO, Rossana Pulcineli Vieira; BERNARDES, Lisandra SteinObjectives Renal development is impaired in fetal growth restriction (FGR). Renal size can be considered a surrogate of renal function in childhood, and could be impaired in that condition. Our aim was to evaluate the ratio of total renal volume, measured by three-dimensional ultrasound, to estimated fetal weight (TRV/EFW) among fetuses with and without growth restriction. Furthermore, we correlated TRV/EFW with fetal Doppler velocimetry and renal vascularization indexes and evaluated the association of renal volume and vascular parameters with adverse neonatal events in growth-restricted fetuses. Methods In a retrospective cohort, TRV and renal vascularization of growth-restricted and normal fetuses were evaluated by three-dimensional ultrasonography and VOCAL technique. Independent samples t-tests and Mann-Whitney test were used for comparisons between groups. Logistic regression model was applied to evaluate the association between renal characteristics and adverse neonatal events. Results Seventy-one growth-restricted fetuses were compared to 194 controls. The TRV/EFW was lower in the growth-restricted group (P < .001). In our sample, this ratio did not correlate with Doppler velocimetry parameters, renal vascular indexes or any adverse neonatal events. Conclusion The TRV/EFW ratio is decreased in FGR. Further studies are needed to investigate the association of this ratio with long-term renal outcomes.
- An unfavorable intrauterine environment may determine renal functional capacity in adulthood: a meta-analysis(2018) SENRA, Janaina Campos; CARVALHO, Mariana Azevedo; RODRIGUES, Agatha Sacramento; KREBS, Vera Lucia Jornada; GIBELLI, Maria Augusta Bento Cicaroni; FRANCISCO, Rossana Pulcineli Vieira; BERNARDES, Lisandra SteinSince studies show that an unfavorable environment during intrauterine development predisposes individuals to several diseases in adulthood, our objective is to assess the relation between fetal growth restriction and chronic renal disease in adults. We searched four different electronic databases through November 2017: CENTRAL, EMBASE, LILACS and MEDLINE. We selected studies with longitudinal or transversal designs associating kidney function in adulthood with low birth weight. Two reviewers evaluated the inclusion criteria and the risk of bias and extracted data from the included papers. Thirteen studies were selected for the systematic review and meta-analysis. We observed increased risks of presenting end-stage renal disease (risk ratio 1.31, 95% confidence interval: 1.17, 1.47), a lower glomerular filtration rate (ml/min) (mean difference 7.14; 95% confidence interval: -12.12, -2.16), microalbuminuria (risk ratio 1.40; 95% confidence interval: 1.28, 1.52) and a small increase in the albumin/creatinine ratio (mean difference 0.46; 95% confidence interval: 0.03, 0.90) in the low birth weight patients, compared with control group. These findings suggest that low birth weight is associated with renal dysfunction in adults.
- Candida parapsilosis candidaemia in a neonatal unit over 7 years: a case series study(2012) MIRANDA, Lourdes das Neves; RODRIGUES, Eliete C. A.; COSTA, Silvia F.; HEIJDEN, Inneke Marie van der; DANTAS, Katia C.; LOBO, Renata D.; BASSO, Mariusa; VARKULJA, Glaucia F.; KREBS, Vera Lucia Jornada; GIBELLI, Maria Augusta Bento Cicaroni; CRIADO, Paulo R.; LEVIN, Anna SaraObjective: To evaluate Candida parapsilosis candidaemia in a neonatal unit over 7 years. Design: Case series study. Setting: A 2000-bed tertiary-care university hospital at Sao Paulo, Brazil. Participants: Neonates hospitalised in a 63-bed neonatal unit. Primary and secondary outcome measures: We evaluated the incidence of C parapsilosis fungemia in a neonatal unit from 2002 through 2008 and the main microbiological, clinical and epidemiological aspects of this disease in neonates. During the study period an outbreak occurred, an infection control programme was implemented, and isolates from blood and hand healthcare workers (HCWs) were submitted to molecular typing. Results: During 7 years, there were 36 cases of C parapsilosis fungaemia and annual incidence varied from 0 to 19.7 per 1000 admissions. Evaluating 31 neonates with fungemia, the mean age at diagnosis was 19 days. All children except for one were premature; all had received total parenteral nutrition and all but one had used central venous catheter. Three neonates had received antifungal treatment previously to the diagnosis. Thirty-day mortality was 45%. Only lower birthweight was associated with mortality. C parapsilosis species complex was isolated from hand cultures in eight (11%) of the HCWs (one isolate was identified as C orthopsilosis). By molecular typing no HCW isolate was similar to any of the blood isolates. Conclusions: The incidence of C parapsilosis fungemia in a neonatal unit varied widely over 7 years. We observed in our series a higher death rate than that reported in European countries and the USA.
- Clinical characteristics and evolution of 71 neonates born to mothers with COVID-19 at a tertiary center in Brazil(2022) DUARTE, Bruna de Paula; KREBS, Vera Lucia Jornada; CALIL, Valdenise Martins Laurindo Tuma; CARVALHO, Werther Brunow de; GIBELLI, Maria Augusta Bento Cicaroni; FRANCISCO, Rossana Pulcineli VieiraIntroduction: Limited data are available on pregnant women with COVID-19 and their neonates.Objective: This study aimed to describe clinical characteristics and evolution from birth to discharge of a retrospec-tive cohort of 71 neonates, with one set of twins, born to women with COVID-19 diagnosed at the end of preg-nancy. The authors included all newborns admitted into a neonatal unit of a tertiary hospital in Brazil, between March 2020 and March 2021, whose unvaccinated mothers had COVID-19 symptoms and RT-PCR (Real-Time Polymerase Chain Reaction) for SARS-CoV-2 positive within fourteen days prior to delivery. Newborns to mothers with COVID-19 symptoms and negative tests for SARS-CoV-2 were excluded. Results: The main route of birth delivery was cesarean, corresponding to 60 pregnant women (84.5%). The fore-most indications for cesarean were pregnant with critical disease (24.6%) and acute fetal distress (20.3%). The mean birth weight was 2452 g (865-3870 g) and the mean gestational age was 345/7 weeks (25-40 weeks). There were 45 premature newborns (63.3%), of which 21 newborns (29.5%) were less than 32 weeks of gestational age. RT-PCR for SARS-CoV-2 on oropharyngeal swabs was positive in 2 newborns (2.8%) and negative in the other 69 newborns (97.2%). Most newborns (51.4%) needed respiratory support. Therapeutic interventions dur-ing hospitalization were inotropic drugs (9.9%), antibiotics (22.8%), parenteral nutrition (26.8%), and photother-apy (46.5%).Conclusion: Maternal COVID-19 diagnosticated close to delivery has an impact on the first days of neonatal life.